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BMC Health Services Research

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Open Access 01-12-2021 | Research

Developing a hospital accreditation model: a Delphi study

Authors: Ali Mohammad Mosadeghrad, Fatemeh Ghazanfari

Published in: BMC Health Services Research | Issue 1/2021

Abstract

Background

Hospital accreditation (HA) is an external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. The Iranian hospital accreditation system faces several challenges. The overall aim of this study was to develop a model for Iran national hospital accreditation program.

Methods

This research uses the modified Delphi technique to develop and verify a model of hospital accreditation. The first draft of the HA model was introduced through a critical review of 20 pioneer accreditation models and semi-structured interviews with 151 key informants from Public, private, semi-public, charity and military hospitals in Iran. Three rounds of Delphi were conducted with 28 experts of hospital accreditation to verify the proposed model. Panel members were selected from authors of research articles and key speakers in the area of hospital accreditation, senior managers of the country’s health system, university professors in the fields of health policy and management across the country.

Results

A comprehensive model for hospital accreditation was introduced and verified in this study. The HA model has ten constructs of which seven are enablers (“Management and leadership”, “Planning”, “Education and Research”, “employee management”, “patient management”, “resource management”, and “process management”) and three are the results (“employee results”, “patient and society results” and “hospital results”). These constructs were further broken into 43 sub-constructs. The enablers and results scored 65 and 35% of the model’s total scores respectively. Then, about 150 accreditation standards were written and verified.

Conclusions

A comprehensive hospital accreditation model was developed and verified. Proper attention to structures, processes and outcomes and systemic thinking during the development of the model is one of the advantages of the hospital accreditation model developed in this study. Hospital accreditation bodies can use this model to develop or revise their hospital accreditation models.

Mosadeghrad AM. Essentials of healthcare organization and management [in Persian]. Tehran: Dibagran; 2015.

Mosadeghrad AM. Comments on Iran hospital accreditation system. Iran J Public Health. 2016;45(6):837–42.PubMedPubMedCentral

Pomey MP, Contandriopoulos AP, François P, Bertrand D. Accreditation: a tool for organizational change in hospitals? Int J Health Care Qual Assur. 2004;17(3):113–24. https://doi.org/10.1108/09526860410532757.CrossRef

Greenfield D, Braithwaite J. Health sector accreditation research: a systematic review. Int J Qual Health Care. 2008;20(3):172–83. https://doi.org/10.1093/intqhc/mzn005.PubMedCrossRef

Sounan C, Lavigne G, Lavoie-Tremblay M, Harripaul A, Mitchell J, MacDonald B. Using the accreditation Canada quality Worklife revalidated model to predict healthy work environments. Clin Health Promot Res Best Pract Patients Staff Commun. 2012;2(2):51–8.CrossRef

Shaw CD. Evaluating accreditation. Int J Qual Health Care. 2003;15(6):455–6. https://doi.org/10.1093/intqhc/mzg092.PubMedCrossRef

Almasabi M, Thomas S. The impact of Saudi hospital accreditation on quality of care: a mixed methods study. Int J Health Plann Manag. 2017;32(4):e261–78. https://doi.org/10.1002/hpm.2373.CrossRef

Oliveira JL, Magalhães AM, Bernardes A, Haddad MD, Wolff LD, Marcon SS, et al. Influence of hospital accreditation on professional satisfaction of the nursing team: mixed method study. Rev Lat Am Enfermagem. 2019;27:1–11.

Schmaltz SP, Williams SC, Chassin MR, Loeb JM, Wachter RM. Hospital performance trends on national quality measures and the association with joint commission accreditation. J Hosp Med. 2011;6(8):454–61. https://doi.org/10.1002/jhm.905.PubMedCrossRef

10.

Mosadeghrad AM, Akbari Sari A, Yousefinezhadi T. Evaluation of accreditation effects in hospitals [in Persian]. Tehran Univ Med J. 2019;76(12):804–12.

11.

El-Jardali F, Jamal D, Dimassi H, Ammar W, Tchaghchaghian V. The impact of hospital accreditation on quality of care: perception of Lebanese nurses. Int J Qual Health Care. 2008;20(5):363–71. https://doi.org/10.1093/intqhc/mzn023.PubMedCrossRef

12.

Alkhenizan A, Shaw C. Impact of accreditation on the quality of healthcare services: a systematic review of the literature. Ann Saudi Med. 2011;31(4):407–16. https://doi.org/10.4103/0256-4947.83204.PubMedPubMedCentralCrossRef

13.

Heuer AJ. Hospital accreditation and patient satisfaction: testing the relationship. J Healthc Qual. 2011;26(1):46–51.CrossRef

14.

Hosford SB. Hospital progress in reducing error: the impact of external interventions. Hosp Top. 2008;86(1):9–20. https://doi.org/10.3200/HTPS.86.1.9-20.PubMedCrossRef

15.

Braithwaite J, Greenfield D, Westbrook J, Pawsey M, Westbrook M, Gibberd R, et al. Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study. BMJ Qual Saf. 2010;19(1):14–21. https://doi.org/10.1136/qshc.2009.033928.CrossRef

16.

Haj-Ali W, Karroum LB, Natafgi N, Kassak K. Exploring the relationship between accreditation and patient satisfaction–the case of selected Lebanese hospitals. Int J Health Policy Manag. 2014;3(6):341–6. https://doi.org/10.15171/ijhpm.2014.116.PubMedPubMedCentralCrossRef

17.

Ng K, Leung GK, Johnston JM, Cowling BJ. Factors affecting implementation of accreditation programmes and the impact of the accreditation process on quality improvement in hospitals: a SWOT analysis. Hong Kong Med J. 2013;19(4):34–46.

18.

Sekimoto M, Imanaka Y, Kobayashi H, Okubo T, Kizu J, Kobuse H, et al. Impact of hospital accreditation on infection control programs in teaching hospitals in Japan. Am J Infect Control. 2008;36(3):212–9. https://doi.org/10.1016/j.ajic.2007.04.276.PubMedCrossRef

19.

Chen J, Rathore SS, Radford MJ, Krumholz HM. JCAHO accreditation and quality of care for acute myocardial infarction. Health Aff. 2003;22(2):243–54. https://doi.org/10.1377/hlthaff.22.2.243.CrossRef

20.

Andres EB, Song W, Song W, Johnston JM. Can hospital accreditation enhance patient experience? Longitudinal evidence from a Hong Kong hospital patient experience survey. BMC Health Serv Res. 2019;19(1):623. https://doi.org/10.1186/s12913-019-4452-z.PubMedPubMedCentralCrossRef

21.

Gimeno D, Felknor S, Burau K, Delclos G. Organisational and occupational risk factors associated with work related injuries among public hospital employees in Costa Rica. Occup Environ Med. 2005;62(5):337–43. https://doi.org/10.1136/oem.2004.014936.PubMedPubMedCentralCrossRef

22.

Sack C, Scherag A, Lütkes P, Günther W, Jöckel KH, Holtmann G. Is there an association between hospital accreditation and patient satisfaction with hospital care? A survey of 37000 patients treated by 73 hospitals. Int J Qual Health Care. 2011;23(3):278–83. https://doi.org/10.1093/intqhc/mzr011.PubMedCrossRef

23.

Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 health care facilities. Arch Intern Med. 2002;162(16):1897–903. https://doi.org/10.1001/archinte.162.16.1897.PubMedCrossRef

24.

Nandraj S, Khot A, Menon S, Brugha R. A stakeholder approach towards hospital accreditation in India. Health Policy Plan. 2001;16(suppl_2):70–9.PubMedCrossRef

25.

Mosadeghrad AM. Iran hospital accreditation: Future directions. In: Braithwaite J, et al., editors. Health Care Systems: Future Predictions for Global Care, Taylor & Francis; 2018. p. 285–91.

26.

Mosadeghrad AM, Akbari-sari A, Yousefinezhadi T. Evaluation of hospital accreditation standards [in Persian]. Razi J Med Sci. 2017;23(153):43–54.

27.

Iran Health Ministry, Implementation guideline of the 4^th hospital accreditation survey. Ministry of Health. 2019.

28.

Mosadeghrad AM, Ghazanfari F. Iran hospital accreditation governance: Challenges and solutions payavard. 2020;14(4):311–32 [In Pesian].

29.

Ghazanfari F, Mosadeghrad AM, Jaafari Pooyan E, Mobaraki H. Iran hospital accreditation standard: challenges and solution. Int J Health Plann Manag. 2021;36(2):1–18.

30.

Reisi N, Raeissi P, Sokhanvar M, Kakemam E. The impact of accreditation on nurses' perceptions of quality of care in Iran and its barriers and facilitators. Int J Health Plann Manag. 2019;34(1):e230–40. https://doi.org/10.1002/hpm.2642.CrossRef

31.

Moradi R, Nemati A, Bahmanziari N, Shokri A, Mohammadi M. The impact of accreditation on services of Isfahan University hospitals. Health Care Manag J. 2015;6(3):67–76.

32.

Mosadeghrad AM, Akbari-sari A, Yousefinezhadi T. Evaluation of hospital accreditation method [in Persian]. Tehran Univ Med J. 2017;75(4):288–98.

33.

Pourreza A, Mosadeghrad AM, Zoleikani P. The impact of accreditation on the performance of hospital emergency departments. J Health Based Res. 2017;3(3):277–95 [in Persian].

34.

Mosadeghrad AM, Shahebrahimi SS, Ghazanfari M. Exploring the relationship between accreditation and hospital performance: using data mining approach [in Persian]. J School Public Health Institute. 2018;16(1):33–50.

35.

Jaafaripooyan E, Sharifi T, Yekani Nejad MS, Esmaeili S. Relationship between accreditation rank and technical efficiency of hospitals affiliated to Tehran University of Medical Sciences [in Persian]. J Hosp. 2018;17(2):49–57.

36.

Fotuhi MA, Khoshgoftar A, Bakhshande A, Karami Q, Rasti M. Evaluation of viewpoint of executive management team of hospitals of Qom Province in terms of the third generation of hospital accreditation standards. Qom Univ Med Sci J. 2018;12(5):62–70.CrossRef

37.

Yarmohammadian M, Shokri A, Bahmanziari N, Kordi K. The blind spots on accreditation program. J Health Syst Res. 2013;9(1):1158–66.

38.

Mohebbifar R, Rafiei S, Asl AM, Ranjbar M, Khodayvandi M. Association between hospital accreditation and patient satisfaction: a survey in the western province of Iran. Bangladesh J Med Sci. 2017;16(1):77–84. https://doi.org/10.3329/bjms.v16i1.31137.CrossRef

39.

Mosadeghrad AM, Yousefinezhadi T. Evaluation of hospital accreditation implementation in Iran. Payesh. 2019;18(1):23–35.

40.

Tashayoei N, Raeissi P, Nasiripour AA. Challenges of implementation of hospital accreditation in Iran: an exploratory factor analysis. J Egypt Public Health Assoc. 2020;95(1):1–10.CrossRef

41.

Yousefinezhadi T, Mosadeghrad AM, Hinchcliff R, Akbari-Sari A. Evaluation results of national hospital accreditation program in Iran: the view of hospital managers. J Healthcare Qual Res. 2020;35(1):12–8. https://doi.org/10.1016/j.jhqr.2019.08.008.CrossRef

42.

Mosadeghrad AM, Nabizade Z. Evaluation of Iranian hospital accreditation system [in Persian]. Payesh. 2018;17(6):617–29.

43.

Gustafson DH, Shukla RK, Delbecq A, Walster GW. A comparative study of differences in subjective likelihood estimates made by individuals, interacting groups, delphi groups, and nominal groups. Organ Behav Hum Perf. 1973;9(2):280–91. https://doi.org/10.1016/0030-5073(73)90052-4.CrossRef

44.

Mosadegh A, Akbari-Sari A, Rahimitabar P. Health system governance in Iran: a Delphi study. Sci J School Public Health Institute Public Health Res. 2020;17(4):319–36.

45.

Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13(1):117. https://doi.org/10.1186/1471-2288-13-117.PubMedPubMedCentralCrossRef

46.

Glaser B, Strauss A. The discovery grounded theory. Strategies for qualitative inquary. Obesvation. London: Wiedenfeld and Nicholson; 1976.

47.

Powell C. The Delphi technique: myths and realities. J Adv Nurs. 2003;41(4):376–82. https://doi.org/10.1046/j.1365-2648.2003.02537.x.PubMedCrossRef

48.

Donabedian A. The quality of care: hHow can it be assessed? JAMA. 1988;260(12):1743–8. https://doi.org/10.1001/jama.1988.03410120089033.PubMedCrossRef

49.

Ghiasipour M, Mosadeghrad AM, Arab M, Jaafaripooyan E. Leadership challenges in health care organizations: the case of Iranian hospitals. Med J Islam Repub Iran. 2017;31(1):560–7. https://doi.org/10.14196/mjiri.31.96.CrossRef

50.

Beer M. Why total quality management programs do not persist: the role of management quality and implications for leading a TQM transformation. Decis Sci. 2003;34(4):623–42. https://doi.org/10.1111/j.1540-5414.2003.02640.x.CrossRef

51.

Waldman DA, Lituchy T, Gopalakrishnan M, Laframboise K, Galperin B, Kaltsounakis Z. A quality analysis of leadership and quality improvement. Leadersh Q. 1998;9(2):177–201. https://doi.org/10.1016/S1048-9843(98)90004-2.CrossRef

52.

Lawrence DM, Early JF. Strategic leadership for quality in healthcare. Qual Prog. 1992;25(4):45–8.

53.

Kaynak H, Hartley JL. A replication and extension of quality management into the supply chain. J Oper Manag. 2008;26(4):468–89. https://doi.org/10.1016/j.jom.2007.06.002.CrossRef

54.

Russel RS, Taylor BW. Operations management: quality and competitiveness in a global environment, 5th ed. N Y: Wiley; 2006.

55.

Hatfield M, Sonnenschein HF, Rosenberg LE. Exceptional returns: the economic value of America’s investment in medical research. 2001. [Accessed 21 August 2008]. http://www.laskerfoundation.org/advocacy/pdf/exceptional.pdf.

56.

Murphy K, Topel R. The economic value of medical research. Chicago: University of Chicago Press; 1999.

57.

Oakland JS. Total quality management: text with cases. 3rd ed. Oxford: Butterworth-Heinemann; 2003.

58.

Akao Y. Quality function deployment: integrating customer requirements into product design. Cambridge: Productivity Press; 1990.

59.

Kanji GK, Asher M. Total quality management process: a systematic approach. Oxford: Carfax Publishing; 1993.

60.

Gemme EM. Retaining customers in a managed care market. Mark Health Serv. 1997;17(3):19–21.PubMed

61.

Baidoun S. An empirical study of critical factors of TQM in Palestinian organizations. Logist Inf Manag. 2003;16(2):156–71. https://doi.org/10.1108/09576050310467296.CrossRef

62.

Shea CM, Howell JM. Organisational antecedents to the successful implementation of total quality management: a social cognitive perspective. J Qual Manag. 1998;3(1):3–24. https://doi.org/10.1016/S1084-8568(99)80101-1.CrossRef

63.

Deming WE. Out of the crisis. Cambridge: Cambridge University Press; 1986.

64.

Yusefi A, Kavosi Z, Heydari R, Siavashi E. The barriers against strategic plan implementation from managers’ perspectives in teaching hospitals of Shiraz University of medical sciences [in Persian]. Sadra Med Sci J. 2017;5(2):87–98.

Title: Developing a hospital accreditation model: a Delphi study
Authors: Ali Mohammad Mosadeghrad
Fatemeh Ghazanfari
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2021
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-021-06904-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Developing a hospital accreditation model: a Delphi study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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